paper was written by the late Colin Campbell and presented to the Owen Sound Support
Group in July 2004. Collin was a mechanical engineer who had radiation as the
primary treatment for prostate cancer. The radiation caused impotence, incontinence,
and proctitis. The radiation nevertheless failed and the cancer recurred. Salvage
Cryotherapy was attempted, but the cancer had become systemic so it was too late.
At the time of writing this piece, the author was undergoing androgen deprivation
therapy (ADT). You can read his story
Colin did not respond to a reminder to update his story in June 2007 and it seems
likely that he has passed on.
Of all the options
for the treatment of Prostate Cancer, Cryosurgery is least mentioned. Yet Cryosurgery
is an effective treatment for prostate cancer and should be considered more often
than it is.
Men who are diagnosed with prostate cancer are usually advised
to have the therapy their urologist is most familiar and comfortable with, which
is understandable. This can be some form of Radiation, Radical Surgery, Brachytherapy
(Radioactive seed implant), Laparoscopic surgery, Intensity modulated radiation
therapy (IMRT), Proton Beam (uncommon). Cryoablation is relatively uncommon.
Men over 70 years are not considered good candidates for Radical surgery,
unless they are in extremely good health, when it may be an option. For this class
of patients, radiation is often suggested. Only rarely is Cryosurgery recommended
The lack of popularity of Cryosurgery is probably because many urologists
have no experience with the technique. Urologists recommend procedures that they
are familiar with, and modern automated Cryosurgery is relatively new on the scene.
It can be shown that modern Cryosurgery, done by an expert, provides cure
statistics comparable to a radical prostatectomy (RP) In addition cryosurgery
is likely to give fewer side effects, while allowing quicker recovery than an
RP. It is well tolerated by men aged 70 or more .As with all therapies, a high
degree of competency is required of the surgeon. Experience is essential for a
The technological advances in the use of 3D Color Doppler
Ultrasound, which is an integral part of modern cryosurgery, give the therapy
a new dimension. This is illustrated in the August 2002 issue of Urology, which
shows excellent outcomes over seven years, and six hundred men who had been treated
using an earlier, less sophisticated technology.
Freezing of cancerous
tissue on skin has been used successfully for many years and indeed is the standard
of care for many tumors. If the tumor can be reduced to minus forty degrees it
dies. Period ! Adjacent healthy tissue is not affected and if the initial treatment
misses any of the cancer it can be repeated as many times as necessary.
Similarly, radiation also kills tumors, provided that sufficient radiation is
applied. However, some tumors require more radiation than is safe for adjacent
healthy tissue. There is an upper limit to radiation that cannot be exceeded.
It usually takes about two years after radiation to tell if the tumor has died.
If radiation is unsuccessful, the patient will probably be left with a more aggressive
cancer and additional radiation is not possible. Radiation may cause collateral
damage to adjacent organs such as the rectum, colon and bladder resulting in radiation
proctitis, bleeding incontinence and impotence!
The American Urology
Association approves primary Cryotherapy and Medicare covers it in the USA.
In Canada, with the exception of the Province of Alberta where Cryo has recently
been approved and covered by the Provincial Health Insurance, there is one urologist
in Windsor Ontario who offers this procedure on a patient pay basis. He was the
second of the author's Cryosurgeons and is highly experienced.